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semi-tertian. Horace speaks in the most casual manner of the 
foolishness of holding out against the disease until the trembling-fit 
causes disaster at the dinner-table. All who could do so left Rome 
in the summer, but the poorer people must have suffered severely, as 
they appear to have slept very often in booths, or open places, thus 
offering themselves as easy victims to the mosquito. Dropsy, a 
frequent result of malaria, seems to have been extremely common. 
Horace says that a man who will not take exercise will certainly fall 
a victim to it, just as we might say that a sedentary occupation must 
cause liver-trouble. 
Here I should like to meet a possible objection. If malaria was 
introduced late in the history of Greece and Rome, why have we 
no mention in ancient writers of the time when it first made its 
appearance? But it must be remembered that on its first intro¬ 
duction malaria would certainly be confused with other fevers 
(typhoid, for instance) already existing in the country. In fact even 
now some kinds of malaria are so like typhoid that the microscope 
alone can distinguish between them. It would be only after some 
time that malaria could be recognised as a separate disease, and as 
late as Galen there is much confusion between the remittent forms 
and other pernicious fevers. But in the case of Italy there is veiy 
likely a reference in the historian Livy to the time when malaria 
first became widely spread over the country. He says that in the 
year 208 B.C., an epidemic occurred which did not result in many 
deaths, but caused much lingering sickness. This looks like an 
epidemic of malaria, and it should be noticed that the date is within 
the period of the Hannibalic War, when the land was laid waste and 
favourable conditions were given to the mosquito. On other grounds 
also, mentioned in this paper, it seems likely that malaria became 
common about 200 B.C. 
The malarial fevers of Greece and Italy were not confined to the 
regular types. Besides the malignant forms included under the 
heading “ semi-tertian,” many other dangerous kinds are distinctly 
mentioned. In two books of the. Hippocratic corpus, Prorrhetics 
and Prognostics , there are frequent references to blackwater fever, 
the algide, hyperpyrexial. comatose and other cerebral forms Again 
and again mention is made of aphasia, loss of memory, ea , 
convulsions and amblyopia as symptoms of certain kinds of ma aria 
